CIDP Masquerading as Mononeuritis Multiplex: The Value of MR Neurography

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for

researchers?

A: Good

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

A: Very Good

Goal

Q: Is the goal explicitly stated in the Introduction? Is its formulation clear and unambiguous?

A: Very Good

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

A: Very Good

Tools and Methods

Q: Are methods the author uses adequate and well used?

A: Good

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

A: Good

Comments: The Discussion establishes that the possibility of asymmetric or multifocal chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), the Lewis-Sumner variant, should be taken into consideration in case of differential diagnosis of suspected mononeuritis multiplex. In this study, the first patient did not satisfy European Federation of Neurological Societies (EFNS)/EAN criteria for CIDP diagnosis while the second patient did satisfy the EFNS/EAN criteria for definite CIDP. The Discussion highlights the importance of magnetic resonance neurography and also how neurophysiology can be misleading, a particular problem if the presentation is atypical. The study recommends contrast enhancement in case there is a suspicion of infection or malignancy. The study concludes that magnetic resonance imaging (MRI) protocols and subsequent interpretation is important in case of abnormality.

Literature

Q: Does the author utilize relevant literature?

A: Good

Author's knowledge

Q: What is the level of the author’s knowledge? Does the author utilize all recent contributions relevant to the topic?

A: Good

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

A: Good

Figures & Tables

Q: Does the author use them suitably? Are legend and notations clear?

A: Good

Writing style

Q: Is it clear and understandable?

A: Good

Comments: Except the following errors were detected:

1.     The words “asymmetric”, “attributable” and “vasculitis” were misspelled.

2.     The full form of “EAN” has not been mentioned in the text section of the manuscript.

Further comments on the paper

Comments: The case report presents the cases of two patients with the Lewis-Sumner variant of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The first patient, a 56-year-old woman, had a 2-year history of asymmetric predominantly distal limb weakness who showed wasting, weakness, areflexia and numbness upon examination. The second patient, a 66-year-old woman, had developed stepwise asymmetric hand/forearm weakness with deformity and areflexia along with mild distal sensory impairment. In case of both the patients the neurophysiological studies suggested mononeuritis multiplex. The second patient eventually showed some demyelination on neurophysiology. A negative response to steroids for suspected peripheral nerve vasculitis led to consideration of the Lewis-Sumner variant of CIDP. The case highlights the importance of use of magnetic resonance imaging (MRI) in establishing a definitive diagnosis of CIDP when clinical and neurophysiology data do not lead to proper diagnosis. The study concludes that MRI can be useful in cases where inflammatory polyneuropathy is suspected despite ambiguous neurophysiology.

Q: Would you recommend this manuscript for further publication?

A: Yes - Suitable to be published

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